Dr Mark Horowitz discusses why psychiatric medication has turned out to be far harder to stop than any one expected.

For Mark, this is as much a personal as well as a professional interest. For as a patient, at one point he was taking five different psychiatric drugs. Ironically, although Mark was working in London at the Institute of Psychiatry, he found the mostly useful information about deprescribing came -  not from the medical profession - but from peer support websites.

This experience has driven his research and interest in safely stopping psychiatric medication. He, along with Professor David Taylor, has just written a new handbook The Maudsley Deprescribing Guidelines, providing step-by-step instructions on how to effectively stop all commonly used antidepressants, benzodiazepines, gabapentinoids and z-drugs.

One of the key findings from this work, is that it is essential to taper off the drugs much more slowly than patients have previously been advised. And perhaps most surprising of all, is  how a small amount of medication can have a completely disproportionate effect. In some cases, a 1mg dose can have nearly half the effect of a 20 mg dose, which means patients may have to taper far more gradually as they move down to smaller and smaller amounts of a drug. A process that may need to take months or even years.

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (The Maudsley Prescribing Guidelines Series) by Mark Horowitz and David Taylor, published by Wiley-Blackwell will be available from 15 February 2024.

The host of the podcast, Liz Tucker is an award winning medical journalist and former BBC producer and director.  You can follow Liz on Twitter at https://twitter.com/lizctucker and read her Substack newsletter about the podcast at https://liztucker.substack.com

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